NEJM Editor Jeffrey Drazen to Retire

After nearly two decades at the helm, Jeffrey Drazen, MD, is stepping down from his position as editor-in-chief of the New England Journal of Medicine (NEJM).

Drazen has announced that he will retire within the next year, and to ensure a smooth transition, he will continue in his leadership role until his successor is named.

"This is the right time for a transition in leadership as the journal looks toward the future," said Drazen in a statement. "I am grateful for the opportunity to have played a part in continuing the journal's long tradition of excellence in medical publishing and in expanding the journal's reach worldwide."

Drazen became editor-in-chief of the NEJM in 2000, and in 2013, he also became editor-in-chief of the NEJM Group. During his tenure, the journal published major papers including the first descriptions of SARS, timely coverage of the Ebola and Zika virus epidemics, and advances in the treatment of cancer, heart disease, and lung disease.

According to the NEJM Group, Drazen led the journal through the publication of many of its landmark studies, including articles on early peanut consumption in infants at risk for allergy, practice-changing research on trastuzumab for HER2-positive breast cancer, and the earliest research on Ebola virus disease in West Africa.

Jeffrey Drazen, MD. Source: Jon Chomitz

He also oversaw many digital innovations on NEJM.org, such as Interactive Medical Cases, Quick Take videos, and Clinical Decisions articles, and during this time, the NEJM Group launched NEJM Knowledge+, a customizable continuing medical education platform, NEJM Catalyst, NEJM Resident 360, and a Chinese translation of NEJM.

"The New England Journal of Medicine is among the best and most reliable medical journals in the world — some would say it is the best — and the editor is everything in the quality of the research that is published," Karen Antman, MD, Boston University Medical Campus Provost and School of Medicine Dean, told Medscape Medical News. "It's an exceptionally important role."

Alain A. Chaoui, MD, president of the Massachusetts Medical Society and a family physician in the Boston area, also noted that Drazen was a visionary leader of the NEJM. "During his tenure, many landmark studies were published, and as for scientific publishing at large, he helped develop policies that led to more transparency, including mandating clinical trial registration, requiring financial disclosures for authors, and making trial protocols and statistical analysis plans available when research is published," he said.

"On a personal level, it has been a pleasure to know Jeff as a colleague and as a friend. It has been inspiring to get an up-close look at his leadership and his impact, and to work alongside a true giant in the world of medical publishing," Chaoui added.

"Research Parasites"

However, Drazen's tenure was not without controversy. Two years ago he ignited a small firestorm for an editorial he coauthored with NEJM Deputy Editor Dan Longo, MD, about data sharing.

They wrote that that a "new class of research person will emerge — people who had nothing to do with the design and execution of the study but use another group's data for their own ends." He referred to them as "research parasites."

The editorial was derided by critics and on social media, where it inspired hashtags such as #ResearchParasites. Many researchers saw it as an argument against open science. Responding to the outcry, Drazen wrote a second piece 4 days later to explain himself and clarify the journal's position.

"The NEJM missed the opportunity to lead the profession on data sharing, instead opting to pen a disastrous and widely lampooned 'research parasite' editorial," said Vinay Prasad, MD, a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University in Portland.

"History will show this was a colossal blunder, and missed opportunity, and emblematic of the journal favoring the trialists over patients," he told Medscape Medical News.

Watering Down Conflicts of Interest

In 2015, the journal ran a controversial series that downplayed concerns about conflicts of interest in medicine, stating that they are oversimplified and overblown. The three-part series by NEJM correspondent Lisa Rosenbaum, MD, along with an editorial by Drazen, also stirred up heated debate.

One point in particular was the journal's change in its own policies on financial disclosures. Previously, authors of research articles had to disclose any funding interests, and authors of editorials and reviews were not permitted to have any conflicts.

But according to an article by ProPublica, the threshold for disclosure was lowered under Drazen. Authors of editorials and reviews now are not permitted to have "significant" ties to industry, which is defined as receiving more than $10,000 annually from a company.

"Financial conflict of interest policies for editorial and reviews were made lax," said Prasad. "This class of article is prone to bias, and the journal made a U-turn from the policies of the Relman-Kassirer-Angell era by permitting conflicted authors to write these articles."

In 1984, the NEJM was at the forefront of a movement to curb potential bias arising from financial ties between industry and physicians, when then-editor Arnold S. Relman, MD, established a new policy requiring authors to name their disclosures.

Several years later Relman made the policy more restrictive by prohibiting authors with financial ties from writing editorials or reviews of medical literature relating to their products. When Drazen came on board he had ties to a number of pharma companies, and he recused himself for 2 years from editing or personally selecting any papers related to those companies.

Prasad also pointed out that the NEJM has declined to reveal the extent of reprint sales, "which may represent a significant conflict of interest at the journal level."

"I suspect history will conclude that the Drazen era was a pro-industry, pro-trialist era, and a dramatic departure from the prior editors," said Prasad. "The same journal that had the prescience to warn of a medical industrial complex in 1980, served to foster and engender that very thing during the tenure of Jeff Drazen."

Pulmonary Specialist

A native of St. Louis, Missouri, Drazen majored in physics at Tufts University, graduating summa cum laude, and then went on to earn his medical degree from Harvard Medical School. He completed his internship and residency at Peter Bent Brigham Hospital in Boston. Drazen has also received honorary degrees from the University of Ferrara, Italy, and the National and Kapodistrian University of Athens, Greece.

Prior to his tenure at the NEJM, he held positions as an associate editor or editorial board member for the Journal of Clinical Investigation, American Journal of Respiratory Cell and Molecular Biology, and American Journal of Medicine.

Currently, Drazen is the Distinguished Parker B. Francis Professor of Medicine at Harvard Medical School, professor of physiology at the Harvard School of Public Health, senior physician at Brigham and Women's Hospital, and adjunct professor of medicine at the Boston University School of Medicine.

Specializing in pulmonology, he has published hundreds of articles and maintains an active research program. In 1999, he delivered the J. Burns Amberson Lecture, the major research address at the annual meeting of the American Thoracic Society, and received the Chadwick Medal in 2000 from the Massachusetts Thoracic Society for his contributions to the study of lung disease.

Looking Ahead

Interestingly, Drazen came on board at the NEJM after the controversial departure of the previous editor-in-chief, Jerome Kassirer, MD, who was asked to step down after 8 years because of his opposition to plans by the Massachusetts Medical Society (publisher of the NEJM) to launch a family of consumer-oriented and specialty-specific medical journals.

Drazen stepped at a time when a number of issues were facing the journal, including how much control the new editor would have over content, editorial policy, and brand name. Marcia Angell, MD, who was executive editor at the time and took over as the interim editor-in-chief — and ultimately withdrew as a candidate for the permanent position to pursue other projects — agreed to fill in only if she was given complete authority over the content, name, and logo of the journal in print and its electronic version.

For now, Drazen will continue to lead the journal until a successor is named. But just as when he came on board in 2000, there are currently several prominent issues the new editor-in-chief will have to grapple with.

"I suspect that some will consider the tenure of Jeff Drazen as a success," said Prasad. "The impact factor went up, the NEJM published many influential trials, of which many were industry-sponsored, some had control arms, some were randomized, and many led to products coming to the US marketplace."

"Yet, the real legacy of the Drazen era is a journal increasingly pulled away from precedent," he emphasized.

Prasad added that "hopefully, the next editor will turn the ship of the institution towards restoring professionalism and ensuring that the journal serves the interests of patients and readers before those of authors and sponsors."

Also commenting on his thoughts for future leadership, Chaoui explained that the "next editor-in-chief should continue to maintain the highest-quality standards for which the New England Journal of Medicine is known, and bring insights on how to meet the evolving needs of physicians and their patients for timely, trustworthy information."

Authors and Disclosures

Authors and Disclosures

Journalist

Roxanne Nelson, RN, BSN

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